Provider Demographics
NPI:1689997546
Name:FARIAD, ZOHRA (RPH)
Entity Type:Individual
Prefix:
First Name:ZOHRA
Middle Name:
Last Name:FARIAD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20-24 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-0000
Mailing Address - Country:US
Mailing Address - Phone:516-797-3036
Mailing Address - Fax:516-797-4256
Practice Address - Street 1:20-24 BROADWAY
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-0000
Practice Address - Country:US
Practice Address - Phone:516-797-3036
Practice Address - Fax:516-797-4256
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048060-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist